Epidemiology of pyogenic liver abscesses in Germany: Analysis of incidence, risk factors and mortality rate based on routine data from statutory health insurance

Abstract Background Millions of citizens in high-income countries face over-indebtedness that implies being unable to cover payment obligations with available income and assets on an ongoing basis. Studies have shown an association between over-indebtedness and health outcomes, independent of standard socioeconomic status measures. Patterns of cost-related medication nonadherence (CRN) among over-indebted individuals are yet unclear. The aim of this study was to examine the frequency of nonadherence to prescribed medications due to cost, and to identify risk factors for CRN among over-indebted individuals in Germany. Methods In 2017, we conducted a cross-sectional survey among over-indebted individuals recruited in 70 debt advice agencies in North Rhine-Westphalia, Germany. Data on CRN in the last 12 months (i.e. not filling prescriptions, skipping or decreasing doses of prescribed medication due to financial problems) were collected by a survey using a self-administered written questionnaire that was returned by 699 individuals with a response rate of 50.2%. Prevalence of CRN was assessed using descriptive statistics. Multiple logistic regression analysis was performed to examine risk factors of CRN, including participants enrolled in statutory health insurance with complete data (n = 521). Results The prevalence of CRN was 33.6%. The chronically ill had significantly greater odds of cost-related medication nonadherence (aOR 1.96; 95% CI 1.27–3.03) than individuals without a chronic illness. CRN was more likely to occur in individuals who had discussed financial problems with their general practitioner (aOR 1.58; 95% CI 1.01–2.47). There was no association between CRN and other sociodemographic factors or socioeconomic status. Conclusions Medication nonadherence due to financial pressures is common among over-indebted citizens enrolled in statutory health insurance in Germany. Stakeholders in social policy, research and health care need to address over-indebtedness to develop strategies to safeguard access to relevant medications, especially among those with high morbidity. Trial registration Arzneimittelkonsum, insbesondere Selbstmedikation bei überschuldeten Bürgerinnen und Bürgern in Nordrhein-Westfalen (ArSemü), (engl. ‘Medication use, particularly self-medication among over-indebted citizens in North Rhine-Westphalia’), German Clinical Trials Register: DRKS00013100. Date of registration: 23.10.2017. Date of enrolment of the first participant: 18.07.2017, retrospectively registered.

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Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04054-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Khaled Gomaa ◽

Ahmed R. Abdelraheim ◽

Saad El Gelany ◽

Eissa M. Khalifa ◽

Ayman M. Yousef ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Mortality Rate ◽

Cesarean Section ◽

Surgical Site Infection ◽

Significant Risk ◽

Tertiary Hospital ◽

Control Group ◽

Site Infection ◽

Incidence Risk

Abstract Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94–1.66). The mortality rate due to SSI was 1.33%. Conclusions The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. Registration Local ethical committee (Registration number: MOBGYN0040).

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Continuity in palliative care – analysis of intersectoral palliative care based on routine data of a statutory health insurance

BMC Palliative Care ◽

10.1186/s12904-021-00751-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Laura Rehner ◽

Kilson Moon ◽

Wolfgang Hoffmann ◽

Neeltje van den Berg

Keyword(s):

Palliative Care ◽

Health Insurance ◽

Statutory Health Insurance ◽

Routine Data ◽

Chi Square ◽

Discharge Management ◽

Care Training ◽

Discharge From Hospital ◽

Ambulatory Health Care

Abstract Background The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient’s death. Methods The analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square. Results In 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice. Conclusions The majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care.

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The incidence, risk factors, and outcomes of acute kidney injury in patients with pyogenic liver abscesses

Clinical and Experimental Nephrology ◽

10.1007/s10157-014-1016-8 ◽

2014 ◽

Vol 19 (3) ◽

pp. 458-464 ◽

Cited By ~ 1

Author(s):

Seong Eun Yun ◽

Dae-Hong Jeon ◽

Min Jeong Kim ◽

Eun Jin Bae ◽

Hyun Seop Cho ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Liver Abscesses ◽

Incidence Risk

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Incidence, Risk Factors and Outcomes of Sepsis in Post-Craniotomy Critical Ill Patients

10.21203/rs.3.rs-423595/v1 ◽

2021 ◽

Author(s):

Jianfang Zhou ◽

Xu-Ying Luo ◽

Guang-Qiang Chen ◽

Hong-Liang Li ◽

Linlin Zhang ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Hospital Mortality ◽

Hospital Costs ◽

Primary Diagnosis ◽

Apache Ii Score ◽

Critical Ill Patients ◽

Hospital Patients ◽

Incidence Risk ◽

Critical Ill

Abstract Background: Data about the epidemiology of sepsis in post-craniotomy critical ill patients are scarce. This study aims to assess the incidence, risk factors, and outcomes of sepsis in this population.Methods: We conducted a prospective cohort study between January 1, 2017, and December 31, 2018, in the intensive care unit (ICU) of Beijing Tiantan Hospital. Patients admitted to ICU after intracranial operations and meeting the inclusion criteria were screened daily for the presence of infection and sepsis. We also collected demographics, primary diagnosis, chronic comorbidities, information about surgery, infection, and patients’ outcomes. Results: Of the 900 included patients, 509 (56.6%) were with infection, and 300 developed sepsis. The cumulative incidence of sepsis was 33.3% [95% CI, 30.2%-36.4%]. Male sex, older in age, supratentorial surgery, the sellar region tumors, postoperative hydrocephalus, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, higher Sequential Organ Failure Assessment (SOFA) score, and lower Glasgow Coma Scale (GCS) were independent risk factors of sepsis. Sepsis was associated with a higher hospital mortality rate (13.7% vs. 8.3%, p =0.012), lower Glasgow Outcome Scale (GOS) at discharge (3 vs. 4, p<0.001), longer ICU length of stay (LOS) (14 vs. 4 days, p<0.001), longer hospital LOS (31 vs. 19 days, p<0.001), and higher total medical costs (RMB 138,394 vs 75,918 Yuan, p<0.001). Conclusions: Sepsis is a frequent complication in post-craniotomy critical ill patients, and is associated with increased hospital mortality rate, increased hospital costs, prolonged ICU LOS, and hospital LOS.Trial registration: Clinicaltrials.gov number: NCT03803813

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